Modified Gluteal Fold V-Y Advancement Flap for Reconstruction After Radical Vulvectomy

Conri, Vanessa; Casoli, Vincent; Coret, Mathilde; Houssin, Clémence; Trouette, R.; Brun, Jean‐Luc

doi:10.1097/igc.0000000000000765

Cited by 9 publications

(20 citation statements)

References 18 publications

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“…One disadvantage of the ALT flap may be color match. Although no studies have directly compared the donor site morbidity of these various options and the ALT flap, their overall rates of complications appear to be comparable and in the range of 10–20%, with all options having a minimal effect on functional outcomes (Benedetti Panici et al, 2014; Chang et al, 2016; Collins, Ayeni, & Thoma, 2012; Conri et al, 2016; Hanasono, Skoracki, & Yu, 2010).…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of a radical total vulvectomy defect with a single split anterolateral thigh perforator flap: A case report and review of the literature

2020

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Reconstruction following total vulvectomy is a reconstructive challenge. Previously described techniques typically require bilateral flaps and the associated donor site morbidity. We present a case of reconstruction after radical total vulvectomy using a single split anterolateral thigh (ALT) perforator flap with a design that optimizes perfusion while allowing for primary donor site closure. A 68‐year‐old female with a history of vulvar squamous cell carcinoma who had previously undergone vulvectomy and radiation therapy presented with local recurrence. The patient required a radical total vulvectomy, resulting in a 12 × 10 cm vulvar defect. A 2‐perforator ALT flap (25 × 7 cm) was harvested, split transversely, and then inset in a circumferential manner around the vulva. This approach contrasts with previous reports, which split the ALT flap longitudinally or centrally, and can compromise perfusion and/or preclude primary donor site closure. The patient healed without complication with 6 months of follow‐up. The described approach allows for total vulvectomy reconstruction using a single ALT flap with a perforator configuration that maximizes perfusion while obviating the need for donor site grafting.

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Section: Discussionmentioning

confidence: 99%

Reconstruction of a radical total vulvectomy defect with a single split anterolateral thigh perforator flap: A case report and review of the literature

2020

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“…No necrosis of the flaps were observed. (Conri et al, 2016). Additionally, in another case series of 5 patients with 7 V-Y advancement flaps, one patient had partial dehiscence after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…(Conri et al, 2016). Their cohort of patients was operated and cared for in the French healthcare system and the patients remained in the hospital until local scar defects were healed to allow for inpatient postoperative nursing care.…”

Section: Discussionmentioning

confidence: 99%

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Utilizing V Y fasciocutaneous advancement flaps for vulvar reconstruction

Hand

Maas

Baka

et al. 2018

Gynecologic Oncology Reports

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ObjectivesWe aimed to analyze the outcomes of patients who underwent vulvectomy with subsequent V—Y fasciocutaneous flap reconstruction.MethodsAll medical records of all patients who underwent vulvectomies with V—Y fasciocutaneous flap reconstruction from January 2007 to June 2016 were retrospectively reviewed. Patient clinical and surgical data, demographics, and outcomes were abstracted.ResultsOf the 27 patients, 42 flaps were transferred. A simple vulvectomy was performed in 8 (30%) patients, partial radical vulvectomy in 15 (56%), and radical vulvectomy in 4 (15%). The median area of defect was 30 cm2. Minor wound separations occurred in 9 patients (33%). Infectious complications occurred in 4 patients (15%); this included urinary tract infections in 2 (50%), postoperative fevers in 2 (50%), and sepsis in 1 (25%) patient with a UTI. There were no instances of flap necrosis, wound dehiscence, or wound infections. Black race was more likely to be associated with an infectious complication with 3 (75%) patients, compared to white race with 1 (4%) patient (p < .01). The presence of diabetes was more likely to be associated with an infectious complication in 2 (67%) patients, compared to 1 (4%) in non-diabetic patients (p < .01). No other significant association was found during analysis of demographics, medical comorbidities, vulvar pathology, or surgical factors affecting V—Y fasciocutaneous flap infectious complications or minor wound separations.ConclusionsThe use of a V—Y fasciocutaneous advancement flap for vulvar reconstruction is safe and associated with mostly minor complications. Infectious complications were more frequently associated with diabetes, black race, and HIV.

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“…(Nakamura et al, 2010) Conri et al found VeY suprafascial gluteal advancement flaps to be safe options for a reliable reconstruction of vulvar defects despite ASA score, age, or BMI. (Conri et al, 2016). Their cohort of patients was operated and cared for in the French healthcare system and the patients remained in the hospital until local scar defects were healed to allow for days1 (0-7) Area of Defect (cm 2 ) 3 0 ( 6 -131) EBL (mL) 50 (5-400) Total Operative Time minutes179 (50-315) Hospital Stay days3 1-7cm 2 = centimeter 2 , mL = milliliters, min = minute.…”

Section: Discussionmentioning

confidence: 99%

Utilizing V-Y fasciocutaneous advancement flaps for vulvar reconstruction

Hand

Maas

Baka

et al. 2017

Gynecologic Oncology

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We aimed to analyze the outcomes of patients who underwent vulvectomy with subsequent VeY fasciocutaneous flap reconstruction. Methods: All medical records of all patients who underwent vulvectomies with VeY fasciocutaneous flap reconstruction from January 2007 to June 2016 were retrospectively reviewed. Patient clinical and surgical data, demographics, and outcomes were abstracted. Results: Of the 27 patients, 42 flaps were transferred. A simple vulvectomy was performed in 8 (30%) patients, partial radical vulvectomy in 15 (56%), and radical vulvectomy in 4 (15%). The median area of defect was 30 cm 2. Minor wound separations occurred in 9 patients (33%). Infectious complications occurred in 4 patients (15%); this included urinary tract infections in 2 (50%), postoperative fevers in 2 (50%), and sepsis in 1 (25%) patient with a UTI. There were no instances of flap necrosis, wound dehiscence, or wound infections. Black race was more likely to be associated with an infectious complication with 3 (75%) patients, compared to white race with 1 (4%) patient (p < .01). The presence of diabetes was more likely to be associated with an infectious complication in 2 (67%) patients, compared to 1 (4%) in non-diabetic patients (p < .01). No other significant association was found during analysis of demographics, medical comorbidities, vulvar pathology, or surgical factors affecting VeY fasciocutaneous flap infectious complications or minor wound separations. Conclusions: The use of a VeY fasciocutaneous advancement flap for vulvar reconstruction is safe and associated with mostly minor complications. Infectious complications were more frequently associated with diabetes, black race, and HIV.

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Modified Gluteal Fold V-Y Advancement Flap for Reconstruction After Radical Vulvectomy

Abstract: The V-Y cutaneous suprafascial gluteal advancement flap for vulvar reconstruction after vulvectomy is an easy, safe, and reliable procedure. However, even mild local scar defect after bilateral flap may impact on wound healing and hospital stay, in elderly and ASA3 patients.

Cited by 9 publications

References 18 publications

Reconstruction of a radical total vulvectomy defect with a single split anterolateral thigh perforator flap: A case report and review of the literature

Reconstruction of a radical total vulvectomy defect with a single split anterolateral thigh perforator flap: A case report and review of the literature

Utilizing V Y fasciocutaneous advancement flaps for vulvar reconstruction

Utilizing V-Y fasciocutaneous advancement flaps for vulvar reconstruction

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